Sam Uretsky

Pharmacists Another Link in Health Chain

ABC News' show 20/20 on March 30 presented a report on chain
pharmacies. Typically for television news, the report lacked depth,
but the basic message came through clearly enough: at many high
volume chain stores, prescriptions are actually filled by teen-age
technicians, and the pharmacists are so rushed that they can't do
their job properly. As a result, mistakes get through the system,
sometimes with tragic results.

This doesn't mean that every chain store sacrifices
professionalism for volume, and it doesn't mean that independent
stores are inherently better. It's not even a problem limited to
pharmacists or pharmacy -- it's just another symptom of a health care
financing system that's busted beyond repair.

Health care professionals, at every level, make a high investment
in education and have reasonable expectations of a decent income.
According to Salary.com, the median salary for a registered nurse is
about $60,000 per year, for a pharmacist about $100,000, and for a
physician $144,000. Dentists do the best, with a median of over
$150,000. Those are respectable incomes, but hardly unreasonable once
you consider the personal investment in education

Part of the reason for going into one of these occupations is the
money, the assurance of a steady job at a comfortable salary, but
another part is the belief that being in the field of health is a
chance to help people.

The problem is that in real life, health professionals are paid,
not by patients, but by insurance companies, and insurance companies
have their own agenda. Insurance companies are in business for their
health, not yours. They need the money. According to Forbes magazine,
William McGuire, of UnitedHealth Group, the nation's leading insurer,
was the third highest-paid CEO in 2005, with a compensation of $124.8
million.

That money has to come from somewhere, and the obvious place is
to pay MDs a little bit less. So, in order to make a living,
physicians have to see more patients, and spend a little bit less
time with each one. A modern medical practice moves with the
precision of the Bolshoi Ballet. After all, your physician not only
has to bring in enough money for her own salary, she has to generate
the income to pay for a billing clerk and a coding clerk, people
whose sole functions are to be sure that everything that's done is
billed for according to insurance company specifications.

So, the physician is rushed, and writes a prescription a bit too
hurriedly. A drug name may be scribbled, or a decimal point may be
misplaced. Stuff happens.

It's the same story at the pharmacy. The payment from the
insurance company not only has to cover the pharmacist's salary, but
if it's a CVS store, has to pay a share of Thomas Ryan's $1,000,000
salary, $3,800,000 bonus, as well as the restricted stock awards and
options. So, as ABC News reported, the technique is simple enough --
hire high school students to prepare the prescriptions, and then have
a registered pharmacist do the checking.

There's nothing inherently wrong with this, until the pace of
filling and checking gets too fast for a careful review, or until the
repeated act of checking and initially gets stultifyingly dull, and
the brain turns off. When the assembly line is going too quickly,
errors slip through, and the system, which is increasingly based on
low payments and high volume, is guaranteed to permit more
errors.

There are answers. In the long run, the answer may be technology
-- more and better computers, systems that don't get overloaded with
work, or bored or distracted, and don't make decimal errors. But in
the short run, we need to rethink how we're paying for health care.
For years there have been proposals to use bar code technology on
drugs, and with some modifications to the system, this could go a
long way to improving safety -- bar codes are used now, but only to
the extent of monitoring inventory and improving profits.

But the first step is to decide that health care is a basic right
not a privilege, and not a commodity to marketed. We're paying for
the best health care in the world. We're entitled to ask why we're
not getting it.